Global Statistics

All countries
343,204,629
Confirmed
Updated on January 21, 2022 4:35 am
All countries
274,173,081
Recovered
Updated on January 21, 2022 4:35 am
All countries
5,593,309
Deaths
Updated on January 21, 2022 4:35 am

Global Statistics

All countries
343,204,629
Confirmed
Updated on January 21, 2022 4:35 am
All countries
274,173,081
Recovered
Updated on January 21, 2022 4:35 am
All countries
5,593,309
Deaths
Updated on January 21, 2022 4:35 am

Prediction Model for Hepatocellular Carcinoma Occurrence in Patients With Hepatitis C in the era of Direct-acting Anti-virals

Abstract and Introduction

Abstract

Background: Several factors associated with hepatocellular carcinoma (HCC) occurrence after sustained virological response (SVR) in patients with hepatitis C have been reported. However, few validation studies have been performed in the era of direct-acting anti-virals (DAAs).

Aims: To develop a prediction model for HCC occurrence after DAA-mediated SVR and validate its usefulness.

Methods: We analysed 2209 patients with SVR and without a history of HCC who initiated DAA treatment at 24 Japanese hospitals. These patients were divided into a training set (1473 patients) and a validation set (736 patients).

Results: In the training set, multivariate Cox proportional hazards analysis showed that the baseline BMI (≥25.0 kg/m2, P = 0.024), baseline fibrosis-4 (FIB-4) index (≥3.25, P = 0.001), albumin level at SVR (<4.0 g/dL, P = 0.010) and alpha-foetoprotein level at SVR (≥5.0 ng/mL, P = 0.006) were significantly associated with HCC occurrence. We constructed a prediction model for HCC occurrence with these four factors (2 points were added for the FIB-4 index, and 1 point was added for each of the other three factors). Receiver operating characteristics curve analysis identified a score of 2 as the optimal cut-off value for the prediction model (divided into 0–1 and 2–5). In the validation set, the sensitivity and negative predictive value for HCC occurrence were 87.5% and 99.7%, respectively, at 2 years and 71.4% and 98.0%, respectively, at 3 years.

Conclusion: A prediction model combining these four factors contributes to an efficient surveillance strategy for HCC occurrence after DAA-mediated SVR.

Introduction

The development of direct-acting anti-virals (DAAs) has led to a high rate of sustained virological response (SVR) in patients with chronic hepatitis C virus (HCV) infection.[1–3] The incidence rates of hepatocellular carcinoma (HCC) occurrence among patients who achieved SVR by DAA treatment were 1.1%-1.9% at 1 year and 1.9%-4.1% at 2 years.[4–7] The HCC incidence rate was lower in patients who achieved SVR by DAA treatment than in those who did not achieve SVR.[8,9] However, there are some populations in which HCC develops after viral eradication. Therefore, continued HCC surveillance after HCV eradication and an efficient surveillance strategy for the detection of HCC according to patient risk are required.

Various baseline and post-treatment factors have been reported as risk factors for HCC occurrence after DAA treatment.[5,6,10–12] In particular, as a post-treatment factor, the alpha-foetoprotein (AFP) level, which was a well-known risk factor throughout the era of interferon (IFN) treatment, was reported to be a risk factor for HCC occurrence in these studies.[5,6,10,11] However, because the observation period of these previous studies was approximately 2 years, further examinations are required. In addition, in these previous studies, the risk factors for HCC occurrence were examined in only the training cohort and were not validated. Few studies have constructed and validated the usefulness of prediction models for HCC occurrence after DAA-mediated SVR.

In the present study, we developed a prediction model for HCC occurrence after SVR and validated its usefulness.

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